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Sane S, Vash RA, Rahmani N, Talebi H, Golabi P, Kalashipour F, Heidari P, Hatami MF, Haki BK, Morwati S. Comparing the Effects of Pregabalin and Clonidine on Postoperative Pain in Tonsillectomy: A Randomized, Double-Blind, Prospective Clinical Trial. Rev Recent Clin Trials 2022; 17:RRCT-EPUB-126500. [PMID: 36154603 DOI: 10.2174/1574887117666220922092953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Tonsillectomy is one of the most common surgical procedures. This study compared the effect of Pregabalin and Clonidine on postoperative pain in adult patients undergoing elective tonsillectomy. METHODS This randomized, double-blind, prospective clinical trial was conducted among 92 patients aged 20 to 50. The clonidine group (C) was given 150 µg of clonidine tablet 90 minutes before surgery, and the pregabalin group (P) was given 300 mg of pregabalin tablet 90 minutes before surgery. The results were analyzed by SPSS 25, and statistical analysis consisted of chisquare, T-test, and χ2 tests, and a p-value less than 0.05 was considered significant. RESULTS The mean pain score and analgesic consumption scores in the pregabalin group were lower than in the clonidine group. According to the t-test, there was a significant difference between the two groups regarding pain score and analgesic consumption (p <0.05). Hemodynamic variation in both groups had no significant differences (p >0.05). CONCLUSION The present study showed that pregabalin reduced postoperative pain and analgesic consumption more effectively than clonidine.
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Affiliation(s)
- Shahryar Sane
- Department of Anesthesiology, Urmia Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
| | - Rahman Abbasi Vash
- Department of Anesthesiology, Urmia Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
| | - Nazila Rahmani
- College of Medical, Veterinary & Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Hadi Talebi
- Department of Medicine, Isfahan University of medical sciences, Isfahan, Iran
| | - Parang Golabi
- Department of Anesthesiology, Omid Charity Hospital, Urmia University of Medical Science, Urmia, Iran
| | - Farid Kalashipour
- Department of Operating Room, Kurdistan University of Medical Sciences, Urmia, Iran
| | - Poneh Heidari
- Department of Medicine, Urmia University of Medical Science, Urmia, Iran
| | | | - Behzad Kazemi Haki
- Department of Anesthesiology, Urmia Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
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Hatsukawa H, Ishikawa M. Clinical potential of pupillary light reflex and heart rate variability parameters as objective indicators of tonsillectomy-induced pain. Physiol Meas 2022; 43. [PMID: 35245910 DOI: 10.1088/1361-6579/ac5ae6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022]
Abstract
Establishing objective indicators of subjective pain intensity is important in pain assessment. Pupillary light reflex (PLR) and heart rate variability (HRV) indicate autonomic nervous system (ANS) activity and may serve as pain indicators because pain can affect ANS activity. In this prospective longitudinal study, we aimed to investigate the potential of PLR/HRV parameters as objective indicators of subjective pain intensity after tonsillectomy. Sixty-seven patients undergoing tonsillectomy were enrolled. Subjective pain intensity based on a numeric rating scale (NRS) and eight PLR/HRV parameters were assessed at five time points. We investigated the changes in the NRS values over time. We estimated regression coefficients reflecting parameter changes per unit change in the NRS score using linear mixed-effects models. The mean NRS score was 0 at two pre-surgery time points, 5 on postoperative days (PODs) 1 and 2, and 0 at postoperative week 3. Two parameters (initial pupil size [INIT] and constriction latency [LAT]) showed significant changes on POD1 and POD2 in comparison to baseline data measured at the pre-surgery time point. Among these parameters, only LAT showed no significant changes between POD1 and POD2. Significant regression coefficients with the narrowest 95% confidence intervals were observed for INIT and LAT. Increased NRS scores were associated with decreased INIT and shortened LAT. LAT was a robust indicator of subjective pain intensity. Our patients showed decreased INIT with increased NRS scores, indicating the predominance of the parasympathetic, not sympathetic, tone in pupils. Further studies are required to investigate factors causing this predominance.
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Affiliation(s)
- Hiroatsu Hatsukawa
- Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Higashinannbachou 2-17-77, Amagasaki, 660-8550, JAPAN
| | - Masaaki Ishikawa
- Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Higashinannbachou 2-17-77, Amagasaki, 660-8550, JAPAN
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3
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Shah AA, Shah AA. Minimizing the Risk of Opioid Misuse and Abuse in the Surgical Setting. Orthopedics 2021; 44:353-359. [PMID: 34618639 DOI: 10.3928/01477447-20211001-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The misuse of opioids continues to be a public health problem. Acute post-surgical pain management requires a careful balance between the benefits and risks of opioids. Opioids should be part of a multimodal treatment plan, including the use of nonopioid and nonpharmacologic treatment options. Multimodal pain management allows for individualized treatment and improved patient satisfaction while limiting the risks inherent to opioids, including diversion. Surgeons should avoid overprescribing opioids and have a plan for decreasing the use of opioids in the postsurgical time frame. With careful consideration of the risks, opioids can be prescribed to treat acute postsurgical pain effectively. [Orthopedics. 2021;44(6):353-359.].
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Miller N, Noller M, Yang A, McCoul ED, Tolisano AM, Riley CA. Lesser Known Uses of γ-Aminobutyric Acid Analogue Medications in Otolaryngology. Laryngoscope 2021; 132:954-964. [PMID: 34536232 DOI: 10.1002/lary.29855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS In otolaryngology, γ-aminobutyric acid (GABA) analogues have been previously analyzed for their roles in neuropathic pain, chronic cough, tinnitus, and perioperative analgesia. The primary aim of this study is to comprehensively summarize and synthesize the existing evidence for lesser known uses of gabapentin and pregabalin in otolaryngology. STUDY DESIGN A scoping review conducted of the available English-language literature was performed by two authors through April 1, 2021. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. RESULTS Ten studies met inclusion criteria. Three studies found that gabapentin may reduce gastrostomy tube usage and improve swallowing function in head and neck cancer patients undergoing radiation therapy (RT). Three studies suggested that gabapentin may help reduce opiate use when used as a primary analgesic in patients with radiation-induced mucositis. One study demonstrated that pregabalin-reduced trismus severity in patients with radiotherapy-induced trismus. One study demonstrated gabapentin may be useful in patients with phonasthenia. Two studies demonstrated that GABA analogues may be a useful adjunct in patients with globus pharyngeus in the context of likely laryngeal sensory neuropathy. CONCLUSIONS The most promising potential uses for GABA analogues identified in this review are for improving swallowing, trismus, and narcotic overuse after RT. The benefit of GABA analogues for improving nonorganic voice disorders is also promising while the benefit for globus pharyngeus when possibly related to laryngeal sensory neuropathy is inconclusive. Laryngoscope, 2021.
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Affiliation(s)
- Nathaniel Miller
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Michael Noller
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Alex Yang
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Edward D McCoul
- Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic, New Orleans, Louisiana, U.S.A.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
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Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:947-961. [PMID: 33201518 PMCID: PMC8247026 DOI: 10.1111/anae.15299] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure‐specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta‐analysis guidelines with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol; non‐steroidal anti‐inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra‐operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first‐line analgesics are contra‐indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
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Affiliation(s)
- N Aldamluji
- Department of Adult Anaesthesiology, Sidra Medicine, Qatar
| | - A Burgess
- Department of Otolaryngology Head and Neck Surgery, Com Maillot-Hartmann Private Hospital, Neuilly sur Seine, France
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H Beloeil
- Department of Anaesthesiology and Critical Care, Université Rennes, Rennes, France
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Kim M, Kacker A, Kutler DI, Tabaee A, Stewart MG, Kjaer K, Sclafani AP. Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery. Otolaryngol Head Neck Surg 2020; 163:1178-1185. [DOI: 10.1177/0194599820933223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0-100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2-week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors. Results A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required. Conclusion Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.
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Affiliation(s)
- Matthew Kim
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Ashutosh Kacker
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - David I. Kutler
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Abtin Tabaee
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Michael G. Stewart
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Klaus Kjaer
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Anthony P. Sclafani
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
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The Effect of Pregabalin on the Prevention of Succinylcholine-Induced Fasciculation and Myalgia. J Perianesth Nurs 2020; 35:255-259. [PMID: 31992495 DOI: 10.1016/j.jopan.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE This study evaluates the effect of pregabalin on fasciculation and myalgia after using succinylcholine. DESIGN This randomized double-blind prospective study was conducted among 100 patients aged 20 to 60 years old. METHODS Pregabalin (300 mg) and placebo (in capsule form) were placed in similar containers. The results were analyzed by SPSS 23 software, and statistical analysis consisted of χ2 test and t test, and a P value less than .05 was considered significant. FINDINGS The mean pain score in the group receiving pregabalin was lower than the placebo group. According to the χ2 test, there was a significant difference between the two groups in the frequency of fasciculation (P = .003). Mean fasciculation severity in the pregabalin group was lower than placebo group. According to t test, there was a significant difference in the mean fasciculation severity between the two groups (P = .002). CONCLUSIONS This study showed that 300 mg of pregabalin was effective in reducing postoperative fasciculation and myalgia in patients treated with succinylcholine.
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8
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Kim DH, Jang K, Lee S, Lee HJ. Update review of pain control methods of tonsil surgery. Auris Nasus Larynx 2019; 47:42-47. [PMID: 31672398 DOI: 10.1016/j.anl.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022]
Abstract
Pain after tonsil surgery is troublesome because it causes discomfort. In addition, handling patients with postoperative pain is challenging to otolaryngologists. Many laboratory studies have assessed the use of analgesics and surgical techniques to discover methods for effective control of postoperative pain associated with tonsil surgery. In this review article, we summarize and provide a comprehensive overview of current methods for the control of pain after tonsil surgery based on findings of recent studies. Although powered intracapsular tonsillotomy is not popular yet, it seems to be an effective option among various surgical techniques. More discussion about powered intracapsular tonsillotomy should be done in the future. On the other hand, surgery with a harmonic scalpel, fibrin glue, or cryoanalgesia seems ineffective. When reviewing medical treatment methods, the use of nonsteroidal anti-inflammatory drugs, steroids, and/or gabapentin/pregabalin seems to be effective. However, the use of opioid (especially codeine) for children should be avoided because of possible respiratory insufficiency. Ketorolac is dangerous because of the risk of hemorrhage. We should continue to focus on the development of novel postoperative pain control techniques with no or low complications.
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Affiliation(s)
- Dong-Hyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of medicine, The Catholic University of Korea, #56, Dongsuro, Bupyung-gu, Seoul 21431, Republic of Korea
| | - Kyungil Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of medicine, The Catholic University of Korea, #56, Dongsuro, Bupyung-gu, Seoul 21431, Republic of Korea
| | - Seulah Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of medicine, The Catholic University of Korea, #56, Dongsuro, Bupyung-gu, Seoul 21431, Republic of Korea
| | - Hyun Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of medicine, The Catholic University of Korea, #56, Dongsuro, Bupyung-gu, Seoul 21431, Republic of Korea.
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Martins MJ, Martins CPMO, Castro-Alves LJ, Jesus GN, Campos GO, Sacramento BBC, Borges LF, Mello CAB, Alves RL, Módolo NSP. Pregabalin to improve postoperative recovery in bariatric surgery: a parallel, randomized, double-blinded, placebo-controlled study. J Pain Res 2018; 11:2407-2415. [PMID: 30425554 PMCID: PMC6200430 DOI: 10.2147/jpr.s176468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Obesity has been considered as a major public health problem in developed countries for which bariatric surgery has become an important treatment strategy. Postoperative pain, however, is a frequent problem in postoperative management. Pregabalin blocks the development of hyperalgesia and central pain sensitization. The objective of this randomized, placebo-controlled, double-blinded trial was to evaluate the effect of a single dose of preoperative pregabalin vs placebo on the quality of postoperative recovery in patients undergoing bariatric surgery. Patients and methods A total of 70 patients undergoing abdominal gastroplasty were randomly assigned to receive oral pregabalin (75 mg) or an identical placebo 1 hour before surgery. The primary outcome was Quality of Recovery-40 (QoR-40) score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. P<0.05 was considered to indicate statistical significance. Results In all, 60 of the 70 patients completed the study. The mean (SD) global recovery scores (QoR-40) 24 hours after surgery in the pregabalin and control groups were 183.7 (9) and 182.1 (12), respectively (mean difference=1.6, 95% CI -7.36 to 4.2, P=0.59). There was no significant difference in the total opioid consumption in the 24 hours following surgery between the two groups (pregabalin vs control=0.47×0.2; mean difference=0.26, 95% CI -0.24 to 0.77, P=0.3). There were no significant differences in nausea, vomiting, or time to postanesthesia care unit discharge between the two groups. Conclusion In patients who underwent bariatric surgery, a single preoperative dose of pregabalin (75 mg) did not improve pain relief, quality of postoperative recovery, or reduction in opioid consumption. Clinical trial registration http://www.ensaiosclinicos.gov.br (identifier: RBR-2g89x8).
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Affiliation(s)
- Marcelo J Martins
- Department of Anesthesiology, São Paulo State University (UNESP), São Paulo, Brazil,
| | | | | | | | | | | | | | | | - Rodrigo Leal Alves
- Department of Anesthesiology, Hospital Sao Rafael, Salvador, Bahia, Brazil
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El-Hussiny H, Fahmy H, Eldemrdash AM. Preoperative Sedation, Hemodynamic Stability during General Anesthesia and Improving Postoperative Pain: Pregabalin Is the Answer. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojanes.2017.81002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Rezaeian A. Administering of pregabalin and acetaminophen on management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery. Acta Otolaryngol 2017; 137:1249-1252. [PMID: 28784038 DOI: 10.1080/00016489.2017.1358464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Management of postoperative pain is a common problem in endoscopic sinus surgery. The objective of this study is the evaluation of pregabalin and acetaminophen effects on the management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery (FESS). MATERIALS AND METHODS In this clinical trial, double-blinded study, 70 patients with nasal polyposis who have indication of FESS were enrolled to this study. After operation, patients were divided randomly into pregabalin and acetaminophen therapy groups. The pregabalin group (n = 35) was treated under pregabalin 50 mg TDS and the acetaminophen group (n = 35) was treated under tablet acetaminophen 500 mg/6 h. Each group was administered for 3 d. The visual analogue scale (VAS) was measured in onset, 12, 24, 48 and 72 h after surgery. All data were entered into SPSS software (SPSS Inc., Chicago, IL) and appropriate statistical tests were assessed to every relation. RESULTS In this study, there was no significant difference between two groups according to VAS in onset (p = .37); however, VAS in 12, 24, 48 and 72 h after operation was significantly lower in the pregabalin group compared with the acetaminophen group (p < .0001, for every four). Also in the pregabalin group, adverse effects were significantly lower than the acetaminophen group (p < .03). CONCLUSIONS Pregabalin has more effect, safely and usefully than acetaminophen on the management of postoperative pain in the patients with nasal polyposis undergoing functional endoscopic sinus surgery.
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Affiliation(s)
- Ahmad Rezaeian
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Liébana-Hermoso S, Manzano-Moreno FJ, Vallecillo-Capilla MF, Olmedo-Gaya MV. Oral pregabalin for acute pain relief after cervicofacial surgery: a systematic review. Clin Oral Investig 2017; 22:119-129. [PMID: 29101547 DOI: 10.1007/s00784-017-2272-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 10/26/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objectives of this systematic review were to unify criteria on the effectiveness of oral pregabalin to treat acute post-operative pain after cervicofacial surgery, to establish the most effective dose regimens, and to determine its effect on rescue medicine consumption and its association with adverse effects. MATERIALS AND METHODS PubMed/Medline (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases were searched for studies in any language published between January 2000 and September 2016. The following question was posed, in accordance with PRISMA guidelines: Is oral pregabalin effective and safe for the relief of acute pain after cervicofacial surgery? The critical reading of the literature utilized a list of questions prepared by the CASPe Network, applying the Jadad scale for evaluation of the methodological quality of trials. RESULTS Eleven randomized controlled clinical trials were selected. The 11 trials obtained a score ≥ 3, considered as Ib evidence level and high quality. A single oral dose of 75-mg pregabalin before or after cervicofacial surgery alleviates pain and lessens the need for rescue analgesia consumption, while the statistical significance of these effects is higher with a single dose of 150-mg pregabalin, either before or after the surgery. CONCLUSION Oral pregabalin appears to significantly alleviate post-operative pain and reduce rescue analgesia consumption, with no severe adverse effects. However, the ideal dose and most effective administration regimen remain controversial issues that need to be addressed in further high-quality clinical trials. CLINICAL RELEVANCE These findings suggest that pregabalin may be useful for acute pain relief after cervicofacial surgery.
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Affiliation(s)
- Sara Liébana-Hermoso
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Francisco Javier Manzano-Moreno
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain. .,Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, 18071, Granada, Spain. .,Biomedical Group (BIO277), University of Granada, Granada, Spain. .,Instituto Investigación Biosanitaria, ibs, Granada, Spain.
| | - Manuel Francisco Vallecillo-Capilla
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, 18071, Granada, Spain
| | - Maria Victoria Olmedo-Gaya
- Master of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Department of Stomatology, School of Dentistry, University of Granada, Colegio Máximo s/n, 18071, Granada, Spain
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13
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Fabritius M, Strøm C, Koyuncu S, Jæger P, Petersen P, Geisler A, Wetterslev J, Dahl J, Mathiesen O. Benefit and harm of pregabalin in acute pain treatment: a systematic review with meta-analyses and trial sequential analyses. Br J Anaesth 2017; 119:775-791. [DOI: 10.1093/bja/aex227] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 12/16/2022] Open
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14
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Abstract
Pediatric post-tonsillectomy analgesia continues to be highly debated and an area of active research. Tonsillectomy pain can lead to significant patient morbidity, and incur potentially avoidable healthcare costs. Moreover, the various analgesic classes, each present their own risk profiles and unique side effects when used in children post-tonsillectomy. This review delineates the clinical and pathophysiological basis for post-tonsillectomy pain, types of analgesics and their risk profiles, as well as special considerations in this clinical population and a review of alternative analgesic treatment options. This article presents a summary of recent literature and discusses evidence-based management options to aid medical and allied health professionals who may encounter these patients.
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Affiliation(s)
- Natasha Cohen
- Otolaryngology, Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Doron D Sommer
- Otolaryngology, Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
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15
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Hwang SH, Park IJ, Cho YJ, Jeong YM, Kang JM. The efficacy of gabapentin/pregabalin in improving pain after tonsillectomy: A meta-analysis. Laryngoscope 2015; 126:357-66. [PMID: 26404562 DOI: 10.1002/lary.25636] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/14/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Gabapentin and pregabalin are useful for treating neuropathic pain because of their antiallodynic and antihyperalgesic properties, which may be beneficial in managing acute postoperative pain. The goal of this meta-analysis was to perform a systematic review of the literature on the effect of gabapentinoids on postoperative pain following tonsillectomy, and its adverse effects in patients. DATA SOURCES MEDLINE, SCOPUS, and Cochrane database. METHODS Two authors independently searched the databases from their inception of article collection to May 2015. Included in the analysis were studies that compared preoperative gabapentinoid administration (gabapentinoids groups) with a placebo or pain control agent (control group) during a 24-hour postoperative period, the outcomes of interest being postoperative pain intensity; rescue analgesic consumption; or adverse effects such as sedation, nausea and vomiting, dizziness, and headache. RESULTS The pain score reported by the physician during the first 8 hours, as well as the need for analgesics during 24 hours postoperatively, were significantly decreased in the gabapentinoids group versus the control group. Additionally, there was no significant difference between gabapentinoids and control groups for adverse effect during 24 hours postoperatively. In the subgroup analyses (gabapentin and pregabalin) regarding pain-related measurements, two subgroups showed the similar effect on reducing the postoperative pain severity. CONCLUSION Preoperative administration of gabapentinoids could provide pain relief without side effects in patients undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of gabapentinoids according to the high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted in order to confirm the results of this study. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Joon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Jin Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon Min Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Myung Kang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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